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Gout gets worse with age, and the accumulated effect of more and more urate. Rare attacks become occasional attacks become frequent attacks and if left untreated, a single permanent attack. Thus in the early stages we may be lulled into the useefulness of finding triggers, eating low on thhe purine scale, etc. but once you have laid down crystals you will never get the point where your body can handle a serum supersaturated with uric acid. Thus, once you have gout you can never return to non-goutedness.
Yes it is human nature to avoid a lifetime of drugs…denial is very much a part of humanity but gout has a way of making the eventual path CRYSTAL
clear.WVPAT,
I strongly recoommend you check your uric acid levels if you haven't already. Perhaps if the level is low enough to warrant conservative control then you could kleep on keeping on. But if you have uric acid levels of 8, 9, or 10, then you need medication to prevent a downward spiral with gout.
In the 6 years since that time, I have not had another attack that severe.
What the usual routine is that, without drugs, you will AGAIN suffer an attack that is even worse than the first…and that will put you on the right path. An attack of gout can be truly merciless…think amputation without anaesthetic. You can wait for it or you can avoid it…most of us wait.
I tried regrinding through that data and I gave myself a headache. Striking though was, from Table 2, the net difference between the highest and lowest quintiles of high purine vegetable consumption…the groups differed by 1 serving per day (whatever they consider a serving.) You cannot make any reasonably valid assumptions from that.
Basically the article said there was little increase in gout risk to someone who eats no high purine vegetables if he switches to eating ALMOST none.
A perfect example of trying to draw too many conclusions out of this data.
Also the data seems to show that REGULAR dairy products protect nearly as well as LOW-FAT dairy.
God knows how they measure protein servings becasue it adds up to a grest deal more than the sum of the meat, fish, dairy and high purine vegetable servingsvegetable…where else can it come from.
But then I cannot be too critical because of the paucity of ANY data on the subject of gout…at least these researchers TRIED.
p.s. WHat exactly ARE these “high purine vegetables” anyhow? THe only things I can find are DRIED mushroom, DRIED, peas, DRIES lentils…obviously drying will concentrate everything but we don't eat DRIED, things we reconstitute them.
modogg said:
I am 6'4″ and 215 lbs.
Target weight from the gout weight tables is 156 to 168 lbs.
Some murds wixxed there because 156 to 168 lb. would be the SS standards for inmates at Buchenwald. At those weights for someone 6'4″one starts looking for cancer.
Something like 190# is probably ideal but 215# isn't too bad at all for someone so tall.
I'd even go further and take the first THREE attacks lightly unless one is frank crucifying Podagra of the bunion joint.
Trouble with ASSUMNING it's gout is that one can ASSUME his way into a lifetime drug treatment and one should not do that lightly.
But once it's proven gout and one is on a urate lowering med, nothing wrong with popping 2 colchicine at the first joint pain of any kind…it will work or it won't with little lost except an extra visit to the throne.
Hi Juliana,
I tried the hash sign substitute (#) but no workee.
If you want to link to a website just open it as normal and copy the address bar with the SELECT/COPY command (no need to type) and PASTE it anywhere in your post…it will be a valid link.
Vegetable purines…I think they are as important as any other but they are few and far between with generally low purine content. BUT I aso believe that purine control for gout is usually a pretty futile efffort. Thus I don't think it matters much to our serum uric acid what vegetables we eat, especially if they take the place of meat and fish.
Try this link:
[edit: link no longer available]
I hope that works for those without a subscription the the New England Journal of Medicine …I have one.
THe study strikes me as particularly weak depending on the participants remembering what they ate in the last two years???? I wouldn't draw too much from it. (How many times have you eaten peas in the last two years?:D:D:D
jamie,
My biggest fear for you is that your new kidney might be underperforming…uric acid is largely removed by kidneys.
NEVER stop allopurinol because of a gout attack. Once started it is FOREVER unless a hypersensitivity reaction develops.
See your nephrologist and have him make the call because keeping that kidney helathy is your most important issue, FAR more important than an aching finger. Are you taking any immunosuppresives?
(Did you get that kidney June 4, 2009 or June, 2004?)
Well of course it worked for me remarkably well. But don't do what I did and take 22 pills; stopping at 16 is quite enough (My instructions had no top limit…not wise.)
Remember, you can also stop when the severe diarrhea starts or the pain stops.
I never got any nausea from colchicine.
Let us know how it goes.
pault said:
Can I still enjoy a few beers if I go on say 100, 200 or even 300mg of daily Allopurinol ? Or will I pickle my liver or something ?
What about steak, prawns etc.?
Can one expect to go back to eating the 'forbidden fruits' when takiing AP ?
Any advice appreciated,
Cheers,
Paul.
My answers are a firm YES, YES, and YES.
rick,
Your method of dealing with your gout is very common and you are getting the common result: increasing frequency and severity of attacks. The end result of this is permanent crippling, chronic gout pain.
To break the cycle you need to get on allopurinol every day, probably one 300 mg. pill. Ideally, you need occasional uric acid monitoring but I know this is out of the question for some of us living in the United States with its medieval private insurance run medical care delivery system. So your MINIMUM is to see a doctor once and get a 3x refillable Rx for 90 pills and take them religiously, FOREVER.
Vince,
THe pain on laughing sneezing etc. doubly points to sciatica probably caused by a ruptured disk (if young) or an arthritic process (if less young :D) in your lower back.
You need a spinal MRI or a CAT scan or at the very least an exam by an orthopedist or orthopedic surgeon.
Do you have any tingling or numbness in your calf?
stu-pod,
First thing to do is to get a baseline uric acid measurement at your doctor. Nothing is more important than that first step (try to get a fasting sample in the morning.)
No,
Tophi do not have to be hard, firm though. THey tend to blanche white for a moment or two when presseed.
THe crystals are mixed with pus, joint fluid, fat and the result is something slippery and creamy almost like a thick white salve. THat's been my experience. Is that how you would decribe your “maggots?”
I will soon attack a small one on my little finger (my only known remaining tophus, at least that is visible.) But not to sound like a broken record there are three words to remember: STERILE, STERILE, and STERILE. I also would never go INTO a joint but rather wait until the tophus rises to just under the skin and looks like it is TRYING to get out. Picture coming as soon as I go shopping and find time to set up the camera.
Another new alternative for those sensitive to allopurinol is febuxostat (Uloric in the United States.) It may be your answer. I rather strongly feel that your nephrologist will go ballistic at the thought of probenecid or any other uricosuric with a donor kidney (especially if a cadaver kidney) because the increased urate exceretion is very hard on the kidneys. I know a woman who has maintained her cadaver kidney for 30 years with daily cyclosporin…but there are very few drugs that she can take.
Febuxostat will cause less urate to form and thus probably HELP your kidney cope.
David,
The VERY important number you have not reported was your uric acid level.
I concur with GP…some mixed herbal nonsense being peddled as a gout cure is just old-fasioned fraudulent quackery, it will always be with us as long as there is a gullible and desperate person suffering. If it actually had any effective ingredients it would need FDA approval. Save your money and get your herbs in a delicious salad instead. 😀
You MAY have gout, you may NOT.
Don't start gout medication until you are sure because it is lifetime treatment. In your case, I think that would mean waiting until you have a clear cut, painful inflammation of one of your feet to go along with another high uric acid reading or two.
I doubt that any doctor will aspirate a hip joint to look for gout but I might be wrong.
(To me, it sounds most like a case of sciatica. Do you remember hurting your back in the last year?)
I've done it with a thumb,
PLEASE be careful…if you get an infection in that joint you will be SO sorry. Clean area with soap and water and alcohol before poking and then rub on an antibiotic cream afterwards.
I always suspected too many sheep would drive a man crazy.
Depends on what you use them for.
Nate,
That’s called “jumper’s knee” an inflamed patellar tendon. Some people get relief by putting a tight band around just below the kneecap. That should help no matter what the cause of the inflammation.
Might be worth a try.
(Somebody tried to convince me that I had it but mine was an inflamed quadriceps tendon…ABOVE the kneecap. It hurt for months and stopped when I gave up the elliptical trainer for several weeks.)
Take heart guys,
Three or Four hundred mg./day of allopurinol will soon put your gout into remission. Make sure that you NEVER forget the old axiom: test uric acid frequently and keep it under, 6.0 mg/dL.
Johnny,
My big attack involved the inability to touch my toe with a FEATHER. In spite of this, I did the BIG colchicine treatment (22 pills) and when the runs hit, I had to get from bedroom to bathroom on my hands and knees with my sore foot held high behind me careful not to even touch the doorway with it. Believe me, it was all worth it when the pain went away over a 5 minute period…almost unbelievable. As the diahrrhea continued on a 5 minute basis I gave up trying to manage it and just kept jumping into the shower and hosing down for the next two hours….foot never hurt again. (Began allopurinol the next week…almost 20 years ago.)
Everything that I've read implies that skim milk is the best protein source for gouties. My guess for the methodology is that the high calcium content of milk causes an alkalinization of the body and perhaps increased urate excretion.
If your numbers are representative d3x, the drop in SUA iis remarklable but I wouldn''t take one set of readings to the bank.
Keep us posted!
Clarenza,
Foot numbness is usually associated with sciatica due to an irritation of one of the spinal nerve roots. In these cases it is almost universal to have buttock pain/numbness and a tingling down the leg that follows the particular nerve root. In my case the damage is either to the nerves at L5-L4 or L5-S1. The numbness goes down the outside of my left calf to my little toe. Thank god it's only occasional from an ancient serious back injury.
My guess is that your GP is correct about the back problem. BUT it MAY well be that uric acid is also involved in some spinal originating pain (and numbness…called paesthesias.) Several doctors have made that claim but as of now it is only hypothesis.
Anything that presses on a nerve for an extended period will cause paresthesia and eventual pain. The sourse is where the numbness begins. If you feel; it only in your foot it might be a tophus; if you feel it in your calf the impingement is from higher up.
Very interesting Mike…I will put that in my information repository as a bit of evidence.
Curious thoughts though:
Placebo group was 60% African American…Vitamin C group 40% African American (Gout is much more prevalent in the black races)
Placebo group had 12% on diuretics…Vitamin C group had only 7% (diuretics cause gout)
Placebo group was eating 49 grams of protein per day…Vitamin C group 54 grams.
I won't say any of these facts damn the significance results but given the small group I think it would be wise to run a larger study.
Using dicalcium phosphate, a rather significant alkalinizer as a placebo for a potent urine acidifier was a particularly poor choice.
But like I say, it is some evidence that Vitamin C is indeed uricosuric. Then one must ask, does it have anything to do with ascorbate or strictly the effect of over-acidification with a strong acid.
Relief,
A 3.0 uric acid (very low) even after 10 days of allopurinol tends to point AWAY from gout. Check back in your records or call your old doctors. One of them MUST have run a uric acid it you were complaining about ankle pain. This number will make or break your gout diagnosis.
You do NOT want to take allopurinol for the rest of your life is there is any doubt about the diagnosis.
(An alternative is to get some colchicine and run a trial to see if it dramatically cuts your foot pain. It is rather ineffective for anything except gout so it tends to aid in a gout diagnosis.)
Johnny,
Do the BIG colchicine treatment:
2 pills to start, then one an hour until you reach 16, get remission of the joint pain, or start a furious diahrrhea. The treatment can work wonders in a single day.
Go into your workplace and show your boss and maybe HIS boss what your joints look like, what drug you are taking, and explain that the disability is likely to be temporary. With a good deal of LUCK the colchicine treatment will be the end of it.
A parking sticker is childsplay but being declared disabled is another. Most states have temporary disability where you basically get the Unemployment Compensation rate but it's called Disability payments for 26 weeks and it is for almost any sickness. But trying for federal Social Security disability with gout will likely run into a brick wall. There is no such thing as temporary Social security disablement…it must be permanent or expected to end in a quick death.
Yes, I recognize the difficulty of putting together a GOOD study, however some studies that limit themselves to a very simple hypothesis like “Does 1500 mg. ascorbic acid lower serum uric acid in men” is precise, simple and can be tested inexpensively. But since nobody will make money from it it will not be done and I guarantee that is HAS not been done.
In other words, if I were to put up thousands of websites that said that quinine cures every known disease in an effort to make a fortune creating a new market for quinine, that wouldn't make quinine any less effective against malaria.
Yes indeed…and by that logic, Vitamin C remains quite effective against scurvy as it will stay until the end of time. Unless of course one is among the whacko pulp scientists or Paulingites who claim that most diseases ARE scurvy (yes, I've seen that as I'm sure you have.)
But in general, I agree with everything you say with one BIG exception:
Although the researchers might not have been directly asking about uric acid and vitamin C, they might have noticed some kind of relationship while looking at something else.
To the extent that any relationship is found in this second-hand way, it is de facto BAD SCIENCE. You find out what you designed a good study to find out…nothing more, nothing less. For example when you design a study to determine whether CELEBREX causes an increased risk of stroke and heart attacks, you don't add “BTW, CELEBREX helps people with gout.” I'm sure we both hold to this Number one requirement:
The Basics of Study Design
(1) There must be a fully formed, clearly stated, focused research question and SINGLE primary outcome measure.
I see no reason why gout should not be viewed like any other disabling condition.
For a handicapped sticker, all that's needed is a note from your doctor.
Some people with advanced chronic gouty arthritis can be as crippled as someone with rheumatoid arthritis. Thank god for allopurinol that prevents this from being an inevitable outcome with gout.
The foot returns to normal color within 1 minute of elevation.
jobu,
That doesn't sound too BAD. It is likely completely normal, or at least GOUT-normal,
because any swelling will cause pressure on the small veins restricting the flow through them somewhat. Just keep it raised as much as possible especially when sleeping…use some sort of bolster under the foot.After having heard over the last 30 years that Vitamin C megadosing cures everything from the common cold to cancer I have grown quite skeptical of its overblown claims. It would seem to me quite simple to design a study of 100 people who have their serum uric acid measured on January 1 and give half of them a placebo and the other half 1500 mg. Measure the uric acid of the 100 people on December 31. Compare the two averages.
A simple enough trial.
The often touted study that fruges refers to required reporting by people about their pain and their Vitamin C dosage. Filling out questionaires is not a good substitute for a double blinded study.
So I remain a skeptic although I recognizing the possibility that overacidifying the body might cause increased urate excretion in the same way that megadosing with aspirin (6 g./day) can…and probably megadosing with hydrochloric acid.
Remember, anything that is reputed to cure ALL diseases probably cures NONE.
Yes,
Inflammation and swelling can take a bluish cast in fact many people regularly refer to a PURPLE toe and purple is half red half blue. But a REAL blue warrants a trip to the doctor.
I would keep my foot raised high as much as possilbe, jobu. It seems you might have some impaired circulation complicating the gout attack. You might want to keep the venous blood draining out as much as possible.
)